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Fidelis Care’s Pharmacy Services would like to provide a reminder and clarity on how to submit claims for medications billed under the member’s medical benefit, as well as the appropriate Servicing Provider to document when submitting a Pharmacy Prior Authorization request for such medications. A Pharmacy Prior Authorization Request form can be found on the Fidelis Care website within the Utilization Management Programs section.   Documenting the Appropriate Serving Provider When submitting a Pharmacy Prior Authorization, the Servicing Provider should be the individual provider, facility, or pharmacy who will be supplying and subsequently billing for the supply of the requested medication.  This should be

You asked and we listened!  Fidelis Care is pleased to announce that claim status letters are now available on Provider Access Online, Fidelis Care’s Provider Portal, in the File Download section.    The letters available on Fidelis Care’s Provider Portal now include: Closed Claim Letter Claim Appeal Letter   To access claim letters: Use the menu on the left of the Provider Access Online home page to navigate to the File Downloads section. On the File Download page can search by File Type and File Created date range. Click on the letter you would like to download.   To check the status of a claim: Use

Annual cultural competency training for participating providers is required by the New York State Department of Health.  At this time, The New York State DOH will only accept the approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training.*   Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the Cultural Competency Attestation Form to: CulturalCompetencyTrainingAttestation@fideliscare.org.   The required Cultural Competency Training needs to be completed annually by December 31st. Providers that completed

The Department of Health has partnered with Public Partnerships LLC (PPL) as the single Statewide Fiscal Intermediary (SFI) for the Consumer Directed Personal Assistance Program (CDPAP). All Consumers and Personal Assistants in the CDPAP must change to PPL by March 28, 2025.   To avoid an interruption of services, members receiving CDPAP services must contact PPL as soon as possible. Providers are encouraged to share this enrollment information with all members receiving CDPAP Services.   How to Register with PPL: ·Option 1: Transition Over the Phone Call the customer support center at 1-833-247-5346, and they will assist the Consumers through the process. Also available: 1-833-278-4829 (Arabic),

In an effort to streamline provider demographic changes and provider termination requests, Fidelis Care has created two new electronic forms for providers to use.  Please use these forms to submit changes under a singular TIN. In order to expedite the request, all fields on the forms are required. If not complete, the request will be delayed. Forms available on fideliscare.org: Provider Demographic Change Request Form   Provider Termination Request Form   Once completed, the forms can be submitted electronically to SMProviderAttestationUpdates@fideliscare.org. In the subject line of the email, please enter Demographic Change/Termination Request for "Your Provider/Group Name" in "Your County" (i.e. Demographic Change Request

Fidelis Care would like to remind our providers of plan changes effective January 1, 2025, for Ambetter From Fidelis Care and Essential Plans. In order for members to obtain the in-network cost share benefit for Diabetes and Maternity Services, providers should follow the below guidance when sending prescriptions to pharmacies for applicable members.   As a reminder, members who become pregnant are required to report their pregnancy to the New York State of Health Marketplace Phone Number below to be eligible for the Pregnancy Cost-Share Waiver. New York State of Health Marketplace Phone: (855) 355-5777 TTY: (800) 662-1220.